Postcode lottery for patients with cancer and heart disease

A close-up of a mammogram x-ray. Photograph: Lester Lefkowitz/Getty images

The NHS spends far more on treating people with diseases like cancer and heart disease in some areas of the country than in others, a study has found.

The King's Fund, which has carried out the analysis, says that after adjustment for the age and the health of the population, there is little explanation for the striking variation on spending from one primary care trust to another, and it probably cannot always be justified.

The research suggests that a postcode lottery in care exists around the country which is not just about the well-publicised reluctance of some primary care trusts to fund certain new and expensive drugs.

The National Institute for Health and Clinical Excellence (Nice) was set up to put a stop to the medicines lottery. All drugs recommended by Nice have to be funded by every PCT in England and Wales, with similar arrangements for Scotland. But the King's Fund's survey suggests that the amount spent per patient with cancer, mental illness or circulatory diseases such as heart disease varies greatly from one PCT to the next.

Knowsley PCT, for instance, spends an average of £118 on a man with cancer, while Ealing spends £47, researchers found. Islington spends £332 per head of its population on mental health, the East Riding of Yorkshire £114. Middlesbrough spends £167 per head on circulatory diseases such as heart disease, but Southwark, in south-east London, spends £76.

"Some of the variations will not solely be as a result of deliberate choices by PCTs," said Prof John Appleby, the fund's chief economist.

"Other factors, such as variations in decisions by clinicians about who and when to treat, and what treatment to provide, and differences in the efficiency of hospitals, will also contribute. But it does raise questions about the consistency of the decisions PCTs make about how much they spend on different diseases."

Niall Dickson, the fund's chief executive, said the survey raised more questions than answers. "It does not mean that any one PCT's spending is necessarily wrong, but it does suggest that as well as unexplained variations in clinical practice, there are unexplained spending variations. Some of these are almost certainly not justified. We need better information about what PCTs spend their money on and what gains in health they achieve."

The fund analysed data collected by the Department of Health from the financial years 2004-05 to 2006-07. It focused on three diseases that are government priorities: mental illness, cancer and circulatory diseases. In those three years, mental health got the most funding, £8.4bn, or 12% of total spending, which was twice as much as cancer received. The report shows that the highest-spending PCT on mental health spent three times more than the lowest, from 25% of the budget to 8%. On cancer, the range was from 3.6% to over 9% of the PCT's budget, and on circulatory diseases the variation was from 5.7% to nearly 11% of budget.

More sophisticated information is being collected about the way PCTs spend their money and what they get for it, which, according to Appleby, will enable better judgments to be made about value for money. "But we have a long way to go," he said. "Tackling unjustified variations in spending will first require much more effort in understanding why variations occur, and second, making determined efforts to change spending patterns to produce a more efficient and fairer NHS."

David Stout, director of the PCT Network, part of the NHS Confederation, said different areas had different patterns of illness, which showed how important it was that spending decisions should be made locally. "However, some of the variations in spend are not explained," he said. "While this may be due to inconsistencies in the data, it may reveal unacceptable variation in clinical practice, or unexplained variation in investment."

A Department of Health spokesman said: "As long as they meet national standards and guidance, the local NHS is free to make decisions on spending priorities based on the character and needs of their local population. Local NHS organisations are answerable to their local populations for the decisions they make."

Care divides

Mental healthTop spender Islington PCT, north London, £332 per head of population Bottom East Riding of Yorkshire, £114 per head of population

CancerTop spender Knowsley PCT, Merseyside, £118 per head of population Bottom Ealing PCT, west London, £47 per head of population

Circulatory diseasesTop spender Middlesbrough PCT, £167 per head of population Bottom Southwark PCT, south-east London, £76 per head of population